The Government of the Republic of Namibia can point to many strengths in its health system. Tax-funded, public health services cover over 80 percent of the population, with most services available for free or minimal charge. A well-developed private health system funded through voluntary insurance covers about 20 percent of people. And there is a large network of primary health care facilities spread across the vast but thinly populated country, with links to district and referral hospitals.
Nevertheless, there are gaps—notably in the quality and availability of care, both of which can vary—and until recently, there was little energy behind efforts to develop a policy to guide improvements. A draft universal health coverage (UHC) policy crafted by a Ministry of Health and Social Services (MoHSS) unit in 2019 received no external input and was never endorsed by ministry leadership.
Universal health coverage (UHC), as defined by the World Health Organization, means that “all people have access to the full range of quality health services they need, when and where they need them, without financial hardship.” Advancing UHC as a global priority was codified with the 2030 Sustainable Development Goals (SDGs): SDG Target 3.8 is to achieve universal health coverage. Unfortunately, progress has stagnated since 2015 in many countries. But in Namibia, efforts to make UHC a reality have regained momentum in the past two years.
In 2022, the Abt-led USAID Local Health System Sustainability Project (LHSS) began working with the government of the Republic of Namibia with renewed focus. And now, thanks to LHSS facilitation, the government is on the verge of approving a new draft UHC policy and a detailed roadmap to implementing it.
Reaching this pivotal point was made possible by LHSS’s ability to re-engage working groups and strengthen the MoHSS’ capacity to engage with multi-sectoral stakeholders on health financing reform. First, the LHSS team took a multi-faceted approach to capacitate the MoHSS to lead these national reform processes. This included the establishing multisectoral UHC governance structures including platforms for engagement at both technical as well as political levels, as well as creating and staffing a dedicated health financing division, which helped the MoHSS manage more consistent and extensive stakeholder engagement. There were trainings to help staff understand the governance structures, and continuous mentoring of key ministry staff.
LHSS then facilitated UHC consultations with key stakeholders, including MoHSS directorates, other Ministries, parliamentarians, private sector, academia, civil society, and development partners. This stakeholder engagement approach to formulating the policy was a stark contrast to the Ministry’s well-meaning but isolated efforts in the past. The result was the development of a comprehensive health financing policy brief, draft UHC policy framework, and a list of prioritized services for possible inclusion in the Essential Health Services Package, which were presented to key stakeholders at a UHC technical meeting in August 2023. The last step is to gain approval from MoHSS leaders and the Cabinet of the Government of the Republic of Namibia, expected in 2024.
“One of the remarkable aspects of the drafting process was its inclusivity,” said L’Oreal Tjiueza, Manager of Insurance & Medical Aid Funds for the Namibia Financial Institutions Supervisory Authority. “Involving health care professionals, policymakers, regulators, medical aid funds, civil society organizations, and representatives from diverse organizations ensured a comprehensive understanding of the challenges and opportunities in health care.”
The draft UHC policy lays out four priority areas:
- Remedying gaps in quality of care, such as reducing wait times and providing patient-centered care
- Addressing persistent health disparities associated with limited access to health services for people in certain geographic areas and socioeconomic groups
- Ensuring widespread availability of preventive and promotive health services at the community level and specialized care at the national level
- Strengthening domestic public health sector financing to sustain and improve access to equitable, quality services for those who rely on public health services.
Likewise, the roadmap contains specifics of how the government will address these issues, reach its goal of UHC, and improve the health of its people.
The prominence of the UHC agenda has increased substantially over the years and UHC reform efforts are receiving substantial support from senior management and political leadership. The private sector had initially been very skeptical about the UHC reforms due to concerns about their own financial sustainability and continued profitability. However, the reiterative and consultative engagement approach has laid many of those fears to rest and has brought some of these stakeholders on board as key partners in the reform process.
Like his counterpart Ms. Tjiueza, Albert Tjaronda of the Ministry of Health’s Policy and Planning Directorate praised the broad stakeholder engagement that revitalized the UHC policymaking effort. He said:
Collaborating with partners and stakeholders to develop our country’s universal health coverage policy offers the advantages of shared expertise, increased access to resources, and a more comprehensive and sustainable healthcare system that ensures better health outcomes for all citizens.
The momentum behind the UHC agenda motivated other MoHSS directorates to also focus their efforts on the goal of improving equity in access to care, with a particular focus on healthcare at the community level where access to health is often limited due to the vast distances to health facilities. And so, LHSS engaged stakeholders to accelerate progress towards a robust social contracting policy. This policy, fundamental to advancing the UHC agenda, secured Cabinet approval quickly and launched in late 2023. This marked a pivotal moment for the sustainability and responsiveness of Namibia’s health system, allowing the Ministry to contract civil society organizations, who are often closest to the communities they serve, to provide health and HIV services.
Achievements like these are not rare on LHSS, USAID’s global flagship initiative for integrated health systems strengthening. Collaborating with diverse health system partners is core to our approach to strengthen local capacity to finance, provide equitable access to, and ensure the quality of essential health services. In 2022-2023, we worked to strengthen health systems in 27 countries in partnership with 720 local collaborators, grantees, contractors and technical assistance recipients.
LHSS’ goal is to support countries’ transition to sustainable, self-financed health systems on the path to expand universal health coverage. And countries like Namibia are on the road to success.